AF - 46699City of Fridley, inn
6431 University Ave. N. E., Mffineapolis, Minn. 55452
BiT�.DING PE�.MIT
��; Map 7,� 1971
�; A 1 W i 1 13 �m_s , g�dps Same
�d� g47-86th Avenue N.E. �d�e3� Same
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��� LOCATIOiV OF BUILDING
Na .� Street Hugo Stxeet N.E. � Part of Lot
Lot 3� 4 Siock R Addition or Sub-Divisian Riverview Hei�hts
Corner Lo� Inside Lot X Setback �� � Sideyard 10 �
$ewer IIevatiaa Foundation IIevation
DESCRIPTION OF BUILbING
To 't� vs� as:
�Dwelling Front 26 � Depth 38 � Height 20 � Sq. �, 988' ��
Front Depth Height Sq. Ft Cu. F'�
R'ype of Construction F'r me F�t, Cost .� �.5, Q00 To be Completed Sept. 1, 1971
. -
Subject to driveway to rea.r house line. Provide hard surface drive. Provide a
verification survey before capping.
WATER LOCATION: 25' East of Manhole
SEWER LOCATION: 14' East of Manhole
Top of Eooting: 829.22 Inv. M.H.: 826.05 Sewer Y E1ev. 826.22
In con�tderai3on of the issuance to me oP a permit to construct 'the building described above, I agree to do
$he pro�sed work in. accordance with tiae d�sc,ription above set forth and in compliance with all provisiona oE
ordina,nces of the dty of Fridley. c
�� _G?%�e���s.�
—
In cansideration of the payment of a fee of $�2.—, permit is hereby granted to A1 Williams
to construci the building or addition as descxibed above. This permit is granted upari
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances oP
1'rYdley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildiage
vyithin the dty ]imits and this pernait may be revoked at any time upoa violation of any of the provisione oP said
ardiaanc�s.
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NOTICE:
This permit doea not sover the construefion, tnstapetion for wirL�s, plum6ing, gas heating, sewer or water. Be soro to �s
�6s Buildfrtg Inspeetor for aeparate permits for theae items.
R,
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : �� ,�,% �' L L � A- �; s BUILDER : _ �'�- � /= ,
ADDRE�aS : �� % � �� `�` � /UI� f�.� ADDRESS : � .�M I�
NO:. STREET:� C� ��. QJ
LOT :s�9 q� � BLOCK: ADDITION : �/ G/L--/�' if� �� �� j,�%S
—7—
CORNER LOT: INSIDE LOT:� SETBACK: �c�`� SIDEYARD:_�
Applicant attach to this form ltao Certificates of Survey of Lot and proposed
building location drawa on theae Certificates.
DESCRIPTION OF BUILDING
To Be Used As : �– �
� � Front: � ( Depth: � � Height: � «
Square Feet : q �� Cubic Feet : / % % � �'
Froat: Depth: Height•
Square Feet; Cubic Feet:
, Type of Construction: � f(�,� �i � Estimated Cost: $�,�'d o�, a�
To Be Completed: � �%` f-- j�7/
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordina.nces aad rulings of the Department of Buildings, and hereby
declares that all the facts and representationa stated ia thia application
are true and corxect.
DATE : � "'� 7 S IGNAT[TRE :
/ F� � �� � !
(See Reverse Side For Additioaal Infosmation.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing pennits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such pex�it of fees to the amount herein below set forth and in
�he manner herein pravided to-wit:
UNIFORM BUILDING CODE: �pe 1, 2& 4-$2,15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pe�its, the cubical contents
of any building or addition, is d�termined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average�
height of the xoof surface of the ma,in gable of a pitched roof.
For repairs or alterations to a.n existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work,
In no case shall the fee charged fos any pezmit as set forth in Section 2 be
Iesa �han $5.00.
VERIFICATION OF FOUNDATION
NOTE: Perniits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, ahowing the location of the foundation, once it
has been constructed, will be required before proceedint� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occup�ed until a Certificate
of Occupansy has been isaued. •
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�01 p1.L. STW ST�E�T '
COLl1F�9�1A W�IGt-0YS 55�21 788-SOa4
1 M��Y C�P3TIFsY tWAT THIfr3 SURVEY. PLAfV, O� ��POiiT ��A9 PRLrPARED �Y ME O[i UPiDLPii k1Y DIRI'cCT SUPERVISION
Ad6D TldAT 1 A�9 OULY RELf3I3TERED LABVD SURV�YORT UPdDPcf3 THE LAtW°3 OF TF4� STATE OF IAINPdEBOTA.
, / DATE �-z�-�r
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Ie�INialESOi�► RP�GISTR/�TION fVO. 5332 0�= IRON MONUMENT
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Lots 3 and 4, Block R, Riverview Heights, Anoka County, Minnesota
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CERTIF'[CATE ,��" S�.JRVEV
JAMES L. KiJRTH
LAND SURVEYOR
Si01 N.B. iTH STREET
CO�UMOIA MEIGMTS 53121 788-SOb4
1 FfillOr C�TI/Y TMAT TMIi SUNVEV. PLAN. OR REPCRT WA8 PREPARSD sY ME OR UNDBR Mr DIRCCT fUPERVI810N
ANO TMAT 1 AM �IdLY R801fTBRED LAND SURVEYOI� UNDER TME tJ►WS OR THE STATE OF MIN�FESOTA.
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SCA LE 1 " _ �Q
MINNESOTA �REGISTRATION NO. 5332 0�= IRON MONUMENT
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HEAT LOSS CALCULATIONS �� ��� DEPARTMENT OF INSPECTION
Weatherstrips A.S.H.V.E, Constructioa No.
Guide
Windows I Daors Re#erence Out. Wall Int. Wall Cxiling Roof Floor Kiad
Yes—No Yes—No 19_
/ F!•�-, "� Room � Length Width !�2 HeiBht � �7.� Room 1
Windows and oors-Crackage and Area Wuadows and Doors—Cn
�Vldth Helght No. of Ltneal ft. Area Wldth Helght No
No. ot Dane ol pane llghta ot crack eq. ft. No. ot pane at pane t16
,.� – ' / �' P � �'J � � � � �. �
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Coef. Btu
Infiltration �. � Infiltration
Glass ��, � 5 ° 3' Gtass
Eap. wall Eap. wall �-- d�' �l
Net ezp. wall �i f Net esp. wall
Int. wall Int. wall
Ceilin8 � ,s . / y �,IJ �, f � Ceiling �' }( j /
Floor �, � �� ,4 Floor � j(,. ) f
Total Btu. / � t�� Total �ta�.
Required sq. ft. E.D.R. or sq. ins. W.A. i..eader area Required sq. ft. E.D.IZ. or sq. ins. W.A. Leader area �
F°1•� ,,t ' Room � Length / Width a�' Height �' ��,� Room � Leagth � Width Height
Windows and Doors—Crackage and Area Windows and Doors—Ccackage and Area
W1dth Hetght No. ot Ltneal tt. Area Wldih HelBht No. oL Lfneal tt. Area
No. ot pane o4 pane ltBhte ot crack eq. it. No. of Dano ot Dane IlBhte of craek eQ. tt.
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MIIVIVEAPOLIS. NIIIY�
Insulation
How
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ot crack ea. tt.
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Net exp. wall /
Iat. wall
Ceiling j a s I 0
Eloor ` • � A
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. i.eader area
Fl, � Room � Length / Width /
Windows and Doors—Crackage and Area
W1dth HefBht No. ot Llneal tt. Area
rrn_ er nane O I D�QB I l B h t e o t c r a c k e q. i t.
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Infiltration � .
Glaaa . °
�p. Wau `r �.
Net e:p. wall /
Int. wall
Ceiling J � ► 1 �'7�.7
Floor ) � / �``✓
Total Btu.
Required aq. ft. E.D.R. or sq. ins. W.A. Leader area
4 ---
Bcu
�
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�838 B
Exp. wall `� �; .S
Net eap. wall �
Int. wall
Ceiling ,�, �� �
Floor � .� � �
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Total Btu.
Required aq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.� Room I Length Width /
I Wiadows and Doore—Crackage and Area
Wldth Hefght No. of Lineal fA Area
.,_ ..� ..e..e �r nnnw ���hte of crack eQ. ft.
Inhltration ,1 ,
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�p. W�u 7 a
Net exp. wall �i
Int. wall
Ceiling G
Floor G � �
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Ltader area
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560-3450
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�nco�A cou�dTY
6431 UR11�tER51YY AVENI•1E NE July 19, 1971 FRIDLEY, lAINNESOTA 55421
�
Mr. A1 Williams
947-86th Avenue �
Coon Rapids, Minnesota
ItE: Change of Addre�s
Dear Sir: .
It has been n�cessary for this office to change the address
of your house
• FROM .611 Hugo Stxeet N.E. TO 617 Hugo Street N.E.
� LE�AI. DESCRIPTION T ots 3& 4��1�R_,,._ Rivervies���h,t�,Addi tion
� ' We have notified the Post Office Department, Minneapolis
Gas Company, I�orthern States Poe��r Company, Northwestern Bell Telephone
Company�and vagfous departments in City Hall of this change.
. �� �
HM/mli
Yours very truly,
HEIdRY P' . MUHICH
�ief Building In�pector
City of Fridley
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Ca.ty of Fridle�, Minn- �� 15 91
6431 University Ave. 1�. E., Minneapolis, Minn. 66432
- -�_ BI,T�.DING PER.MIT
��; August 10, 1972
p��; Casimir Marciniak g�� _ Same & Sus el�
Address ��u...�.4.�Street N.E. Address
LOCATION OF BUILDING
No. 617 ____ S�t ^ Sugo Street N.E. p� o� ��
Lot 3� 4 _ Block �..R _..__ Addition or SubrDivL�on .� Rive�cview Seights
Corner Lot ._ ..____ Inside Lot X Setback —.. Sideyard
Sewer Elevation
Foundation IIevation
DESCRIPTION OF BUILbING
To be Used as:
Garage _�_ Front 24 � Depth 22 � Height 10� Sq. Ft, 528 �, �, 5, 280
— �__ Front Depth Height Sq. Ft Cu. Ft
Type of Construction �ood frame �,� �� 2, 000.00 To be Completed 8/10/�i$
��,391.8
Provide Hard Surface Driveway
In consideration of the issuance to me of a permit to construci the building descr3bed above I agree to do
'�he P=ol�d work in accordance with the description above set forth and in compliance with a�1 provYsions oY
ordiliances of the city of Fridley.
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1 1(i StatP S�yrr av� �
Ia consideration of the payment of a fee of $ 10 . 00
, permit is hereby granted to Casimir Marciniak
to construct the building or addition as descxibed above. This permit is granted upo�i
the express condition that the person to whom it is granted and his agenfs, employees and worl�en, 3a aIl work
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordin�nc�s of
Fridley, Minnesota. regarding location, construction, alteration, maintenanc re air and moving of buildii►g�
vyithin the city limits and this permit may he revoke a ' e upon v��l�� g�ny /1 the provisions of Said
ordinances. �� n
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Svllding Inspector
IaIOTICE:
This permh does not eover t6e eonstruetion, installation fo� wiringf plum6ing, gas heasPug, �wer o� water. Be sure to t9s
t6s Building Inspeefo� fo� separafe permits fo� these items.
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APP�ICATION FOR RESIDENTIAL, A�TEItATION,
OR Allll���ON BUILD�NG p��I�
CITY OF FRIALEY, MINN�SOTA
�nA�� t �7 F�K� i ��jloYll.f(/11� \ / � � BUILDIIt � i� e� �e e�� �s
.ALL�SS i V` .7 �� �fLLl�CW S i
N0: STREET: /�� � � �• �
�; BLOCK: � ADDYTIONi ,�., � �
CORNER LOT: INSIDE LOT:�_SETBACR: SIDEXARD��
,�pp�.icant attach eo this form 7tao Certificates of Survey of Lot aAd propo�ed
building location drawa on these Certificates.
BESCRIPTION OF BUILDING
�o �e IIsed As:
( ���.oh� � Front : �� Depth • o� - Height : � � �
�.e� e� �er
� . .
Square Feet : ,��� Cubic F+eet : ,3, �,� �
! 1� A q
' Front: Depth: Height:
Square Feet; Cubic Feet:
'�rpe qf Construction: �iv�`-� �'/La,��-'� Estimsted Coet: $�@� :���a
�'o $e Completed: � �/� ' %� �„2,/ �' � `` � ��
The undersigned hereby makes applicati�n for a perp�it #or ti�e .wp7c1� �A���
�pec���,ed, agreeiug to do all work in ettict accordance witia the C��► Q�
�lr�,d�.e�► 0=dinaaces aad rulings of the Department of Buildings, and '�e�eby
dec���es that all the facts and representationa atated in thie ap�i�,����,�
a�e true and correct.
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�ATF ; � � � / ��( S IGNATURE :
(See ltever�e Side For AdditioaaY Information.)
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$UILDING PERMIT FEE SCHEDULE
SEC1"�ON 2. The Tnspector of Buildings shall, before issuing permit� fox the
exection of any building or atructure, or for any addition �o any exiatin�
buildiug or structure, or for any alteration or repaire to aay exietiag
bu3,ld�tng ox structure, upon application therefore, require the paymem� by �Yt�
appl�.Cant for such permit of fees to the amount herein below aet fo�rth aud i.0
the manner herein prwided to-wit:
�TNIFORM BUILDING CODE: �pe 1, 2� 4-$2.15 for each one thousand cubi,c
��,��, ox fraction thereof, in such cubical coatenta. Type 3� 5-$�.85 for
e�tch one thousand cubic feet.
ADDITIONAL INFORMATION
Far the purpoae of computi�g fees for building pes�ite, the cubical contents
of anq buildi�g os addition, is determined by multiplyiag the ground area
cavered from a point �ix (6) inches below the floor line of the bases�ent
or the cellar to the avesage heights of the upper surface or to the average�
height of the roof surface of the main gable of a pitched roof.
�Qr repaire or alterations to aa existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fractiaa thereof in
the� cost of all propoaed work.
Ia no case ahall the fee charged for any permit ae set forth in SeGtiAt� � i�e>
less than $5.00.
VFRIFICATION OF FOUNDATION
1�QT�; Permita for eonstruction will be iseued a mini�um of 24 houra f�caq�t th�i
�ime of applicatioa, to allow for proper review of the proposed structuxe atid
of tt►e conatructioa site.
� Ce7ctified Survey of the lot, ehawiag the location of the fouadatiAs�� ql��� �.�
hsa beea constructed, will be required befo�e proceeding with the f�cea�n�*
CERTIFICATE OF OCCUPANCY
Applicatioa for a Certificate.of Occupaacy shall be made ten (10) days �i�iA�
�p the use or occupancy of any structure for which a building permit has b��
iseued; and eaid structure ehall not be used or occup3ed until a Certif�.G���
o� Occupancy has been iaeued.
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J�► b�f E s i.. . IC u Fi �' H
LqND 3URVEYOR
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COLYM�lA MSI�MTS s�1 '� � � �. 7�s�t
! tt�� �otrmr tw►t rM�s w�evtn. ►i�uv. a�e �r Mrns n�rwws� �r M� a� u�a�w �r o��cr suPannsirnv
A� TNAT 1�M �.r �Tf�D LAND WRYlYO�1 ti�f� TI� LAMIf QR Tl1a fTAT6 0I Mfi�U�O'TA.
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SCA LE t " - �_
MINAtE34T�' IREGI�iTRAT10N NO. 5332 a= IRON MONUMENT
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S�x�sr of
lmi� 3 ta�d 4, �focic R, Riverview Heighia, Arwka County, Mi�nesota
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CAL SLAB DETAIL
2- 4 _Re_— 8ars
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12�� Min,
66 x 10
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The above ia a substitute design for frost footings, however, it is not yet
accepted by the State as an amendment to the Uniform Building Co3e, Section 2905,a.
Therefore upon using this method of construction, I agree to hold the City of Fridley
harmless of any possible claim for foundation failure or structural damage caused by
foundation failure.
Witness
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Prop Owner
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Address o roperty/Legal Desc.
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CITYOF
FIZIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
December 8, 1992
Mrs. Narx.y Nlarcini�k
617 Hugo Street
Fridley, NIl�T 55432
Dear Mrs. MarCiniak:
I have received and irrvestigated your request to be reimbursed for having your
sewer service irodded on Nc�v�mber 11, 1992. City crews checked and rodded the
City sewer main that services your property� arid fo�uxl no evidence that the City
seraer main cata��ed your s�wer problem.
My irivestigation ooncluded the sewer stoppage was in your service line, and the
responsibility of the property awner ur�der ex?y�-im City policy.
If you have future problems, plea.se call the Public Works Depar'tment before you
call a pliunber, so the City can check the condition of the City main. The City
has "on call" per�.�onnel available after hours if the problem oocurs at night,
weekends or holidays. If you have any questions, Please ca11 �e at 572-3563.
Sincerely,
C� � �.�
Paul Iawrelxe,
Superintendent of Public Works
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MRY-28-1998 10�13 FROM CITY Or FRIDLEY
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MRY-28-1�98 10:14 F�OM CITY OF FRIPLEY TO
32.��595 P.�4��4 s
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CHIMNEY A,]o1D �TACK VE1�iFiCA'�'I�'It N
'T�e wndersigned hereby verifie.s tha►t t�e existing chimney or stack:
I. � � ��Y � Yes ( ) No ( }
2. �s freE fr�m rust or d�terioratian Xes (� No (}
3. Has no foreign abjectc lodged withiun Xes (} No ()
�. Is securei3' �PP�� 'Yes ( ) �Io ( )
5. Meets alI cutceut Code ret�uuements for size
and total BTU's co�t�d yes { j Nc� ()
6 Has total heating B'Y�tJ''s of
AIl othex B7'LT's
TpTAL, BTU's
7. �3Eas a 1'r,neac been provided for water heater Yes (} No ()
8. F3Eas combustion aiu' 3�i provided for water �eate� Xes () No ()
xs:. C�/�''i'Z� C�/�' ��L����c..L�� / .
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�.is2 �LT`E�tA'�ONS Bem�Done:
kiF.A'T1ING CO:
Signed By:
]bate:
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House Heating Test Record
Address ��� ' !`"�� Apt._Fioor City Suburb �, �
-___�
�p�t Owner
Heat Loss
Sold By.
Date Heating Installed
Installed By
Electricai Work By Gas Line By
Type of Heat GA FA_HW Steam_Space Htr. Unit Htr. Other
Gas Design
�����
Model��' �� � ��
Serial
�t�,e���
Contrnls
Thermostat Heat Plu�_
Valve �
L�t�� ��/�
�
Limit Setting Q
Fan Setting ld�•e�
Pilot Type �f1��.��i��
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut Off
Pre�ure.J � Percent C •�
Input CFH� Percent Oz�.�'
d
Stack Tem�Percent CO �
3°�1
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.
Conversion
Make of Burner
Model
Max. BTU Rating
Make of Furnace
Model
Vent Size
Kind of Liner Size None
Draft Hood Reg�ilator
Filters: Size Number
Chimney Location In�ic�e Outside
Chimney Construction
Smoke Bomb Wiring
Draft Test Tag
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sue�ecT ERMIT NO. \
City of Fridley 2 614 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� `v _ COMMUNITY DEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC.
i-_-_� �'�'�,� CITY MALL FRIDLEV 55432 NUMBER REV DATE PAGE Oi APVROVED BY
L 612-571-34b0 910-F15 6/4I98 / /
J08 ADDRESS
617 Hu o Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3�(F R Riverview Hei hts SHEET
2 PiiOPEFTY OWNER MAIL ADDRESS 21P PMONE
Nanc Casimir Marciniak 617 Hu o Street NE 784-5681
3 CONTRACTOR MAIL ADORESS ZIP PNONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAILAODRESS ZIP PMONE LICENSENO.
8 USE OF BUILDING
oof House 1 S uare 2nd La er
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION X REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Roof - 2nd la er
9 CHANOE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
riPE OF CONST. OCCUPANCV OROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAI, PLUMBING, MEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OF ABANDONED POR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yALUATION SUpTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED
WI7H WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $939 �. SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �3�F.%5 Fire iC �.9�F
'
PLAN CHECK FEE T07AL E
$ 6.19
SIGNATUFEO� N7 CTORORAUTMOIi12EDAGENT IDATEI N P OPE V ALIDAT IS IS VOUR PERMI
a , I s
S�GNAT EOFOW �iFOWNERBUILDER� OATEi NSp r�arE
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ADDN
ALTER
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ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Construction Type:
CITY OF FRIDLEY
5INGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1/1/98
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MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
Driveway Citrb Cut Width Needed:
DESCRIPTION OF IlVIPROVEMENT
Width
Width
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Estimated Cost: $ �� �
(Fee Schedule on Back)
Ft. + 6 Ft = _ Ft x $ _ _ $
,
DATE: �
� " `� � APPLICANT: v Tel. # ?�� �'d f j
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Q �4j ` �
.p �� Fee Schedule on Reverse Side
$ � ` .001 of Permit Valuation (1/1(}th%)
$ . ���� $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.� Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ .��., / �'
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
�$574.�'S for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $SUO,UGU
$2887.25 for the farst $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,0(}0,000
$5012.25 for the f�rst $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPI�CESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Drivewa�, width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
a�